Real World Clinical Blog: Social Work as Moral Compass

“In the midst of winter, I found there was, within me, an invincible summer.” –Albert Camus

Moral Compass

When I started writing this blog more than a year ago, the world felt like a much different place. I am not entirely sure that it was, but it certainly felt like it. Since the election, a feeling of uncertainty has pervaded so many different realms, including everything from health insurance to international policy. Amidst these uncharted waters, social work is not only a ship worth sailing on, but one that might help us all find some sort of shore.

I sit down many mornings nearly paralyzed by the devastating level of needs in our country and abroad. Whether it is the insufficient comfort brought by a full-time minimum wage job or the intensifying and seemingly unending refugee crisis occurring because of the war on Syrian citizens, trauma and injustice abound. I wonder if I should turn toward the news or turn away from it. I wonder what news sources I can even trust. I feel the urge to numb out with capitalist tools, like using my Target Red Card for a 5% discount or ordering extra appetizers at some national chain restaurant.

Then I head to work and have a day of clients ahead of me and remind myself that this is where the cure to these desperate feelings lies. Amidst poverty, war, disenfranchised voters—a theme emerges. The suffering comes down to a few unifying factors—trauma, ruptured attachment, and developmental misattunement. These factors elevate the utmost importance of our work, which is to be with someone who is suffering, in an open, containing, thoughtful, intimate, and tender way.

In his quest to determine how to best treat those suffering after World War II, Carl Jung wrote, “The shoe that fits one person pinches another; there is no recipe for living that suits all cases.” Jung, here, captures the ways in which our work differs from so many other fields. We sit with clients in the service of honoring their idiosyncrasies. We study their attachment patterns, meditate on how their traumatic past is making itself known in the present, and adjust our treatment to honor the truth of their psychological age, rather than their chronological age.

And in response to our studies, we create ways of being, ways of using our selves differentially and create interventions. We know that these interventions don’t come easily, and we know that they don’t always work. We test hypotheses about their usefulness before even implementing them. For example, if we have an addicted client, we don’t say: “Go to a 12-step meeting!” Instead, we ask, “Do you feel like you are ready to go to a 12-step meeting?” or “Can you imagine that a 12-step meeting might feel useful right now?” We collaborate before forcing solutions, and we respect stages of readiness before moving forward.

When we, as social workers, sit with clients, we recognize the truly healing capacity of simple curiosity and attention to detail. If a client tells us that they have a performance this week that they are nervous about, we know how curative it is to remember this the following week and to ask about it. We know that one of the keys to creating internal change in a client’s mind is our ability to demonstrate that they are worthy of being internalized, being remembered, being thought about. We know that the self of the client is brought to life by our willingness to hold their lives in our mind.

We also know that to talk is to heal. We don’t exactly know why, but the edict holds that once something is said out loud, it loses it psychological power. We are in the business of the “talking cure,” Freud’s original idea, that is based on helping others experience the neurobiological relief of connection via verbalization of otherwise seemingly unsayable truths. J. Gary Sparks wrote in his book At The Heart of Matter, that, “It is addressing life in the present that cleanses and heals a festering wound.” We cleanse wounds through tender psychological touch and exploration. We don’t rush our questions, but we don’t shy away from the hard ones either. We allow our clients’ cues to pace our inquiry, without necessarily letting our clients’ defenses control us either.

And, most of all, we know that we are in the business of enriching one’s own conversation with oneself. The true fruit of clinical social work’s labor is the enriching of internal psychic lives. Jung, after diligently studying the etiology of the events of WWII, particularly the psyche of the German people before Hitler’s ascension to power, felt that there had been a loss of focus on the value of inner life. He found that imagination had become deadened in the face of increasing complacency and surrender to multiple status quos. To ward off this complacency, we need to work with our clients to heighten their level of consciousness and ward off levels of destructive unconsciousness. The more our world falls prey to the unconscious forces that perpetuate inequality, hatred, and oppression, the more intense our vulnerability is to neglecting each other.

However, consciousness—the kind that is born out of the intimacy of the clinical dyad—creates, radiates, and metastasizes actual change. Change for the individual, change for a family, change for a work place, change for the world. When we provide individuals with the space to think, to broaden their emotional literacy, to feel what feels un-feelable, we send change agents out into the world—agents ready to share these morally just acts of interpersonal love and relatedness.

This will be my last weekly blog, although I will likely be writing from time to time. This final blog, along with the previous 52, will become part of my next book, which will include my reflections on the field and my photographic art work. The book will study the connection between art, social work, and self-care, while also attending to the many complex dimensions of life in the field of social work.

Dr Danna Bodenheimer

Dr. Danna Bodenheimer

Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. She provides more of her clinical perspective and tips for developing clinicians in her book, Real World Clinical Social Work: Find Your Voice and Find Your Way.

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Comments (4)

Thank you

Thank you for this hopeful reflection--I agree, it's been a difficult year and at times it is hard to remember why we are doing the day to day work one person, one family at a time. Thank you for bringing it back to that connection, that human connection that really is the fabric of our society and of social work.

Rachelmore than 2 years ago

Inspiring article

Thank you, Dr. Bodenheimer, for summarizing so many concepts I talk about with my interns and trainees, both in Social Work, as well as other professions within mental health.

You've effectively addressed the foundation of good psychotherapy, the importance of authentic connection with our clients, the need for establishing an emotional basis to create change in individuals.

Many of my colleagues in community work wonder why the "evidenced-based" techniques and tools they try don't lead to effective outcomes. I routinely say that without the trust and bond between therapist and client, the best researched "tools" will fall flat and seem forced and fake. The confused looks I occasionally get cause me to worry about what is being taught and promoted in the field now.

I'd like your permission to use this article for my clinical supervision group.

Andrew Parimore than 2 years ago

Of course!

I would be honored!

Danna Bodenheimer more than 2 years ago

Effects of face to face interventions

Wouldn't it be lovely if we were truly compensated for the therapeutic interaction. Insurance companies and public third parties have long given a clear message that they are not interested in honoring these claims and seek to avoid paying them. Agencies are discouraging licensed providers from performing therapy services and instead insist on requiring case management services of these personnel in the desperate pursuit of third-party compensation. The result is a number of prematurely diseased providers. It would be more helpful for these agencies to bandit gather and take legal action against the centers for Medicare and Medicaid policy in order that we may be able to perform our tasks in a matter that is possible.

Gregory Rodick, retired LCSWmore than 2 years ago

About Real World CSW

Dr. Danna Bodenheimer is the author of Real World Clinical Social Work: Find Your Voice and Find Your Way and On Clinical Social Work: Meditations and Truths From the Field. She shares practice wisdom with new clinicians.